A tool for routine monitoring and feedback of morbidities following paediatric cardiac surgery.

Luca Grieco,Shane Tibby,Serban Stoica,Christina Pagel,Warren Rodrigues,Katherine L Brown,Victor Tsang,David J Barron,Martin Utley

doi:10.1017/s1047951119002956

Abstract

Short-term survival after paediatric cardiac surgery has improved significantly over the past 20years and increasing attention is being given to measuring and reducing incidence of morbidities following surgery. How to best use routinely collected data to share morbidity information constitutes a challenge for clinical teams interested in analysing their outcomes for quality improvement. We aimed to develop a tool facilitating this process in the context of monitoring morbidities following paediatric cardiac surgery, as part of a prospective multi-centre research study in the United Kingdom.We developed a prototype software tool to analyse and present data about morbidities associated with cardiac surgery in children. We used an iterative process, involving engagement with potential users, tool design and implementation, and feedback collection. Graphical data displays were based on the use of icons and graphs designed in collaboration with clinicians.Our tool enables automatic creation of graphical summaries, displayed as a Microsoft PowerPoint presentation, from a spreadsheet containing patient-level data about specified cardiac surgery morbidities. Data summaries include numbers/percentages of cases with morbidities reported, co-occurrences of different morbidities, and time series of each complication over a time window.Our work was characterised by a very high level of interaction with potential users of the tool, enabling us to promptly account for feedback and suggestions from clinicians and data managers. The United Kingdom centres involved in the project received the tool positively, and several expressed their interest in using it as part of their routine practice.

Highlights

3500 children under the age of 16 years have heart surgery each year in the United Kingdom[1] and since 2000, all cardiac centres have contributed procedure data to the National Congenital Heart Disease Audit
Local routine monitoring of risk-adjusted mortality has been shown to be feasible and acceptable[5], and United Kingdom centres use software developed through a previous research study to do this
We report on the development of a prototype tool to support the routine monitoring by clinical teams of early post-operative morbidities following paediatric cardiac surgery as part of a 4-year prospective multi-centre research study in the United Kingdom

Summary

Introduction

3500 children under the age of 16 years have heart surgery each year in the United Kingdom[1] and since 2000, all cardiac centres have contributed procedure data to the National Congenital Heart Disease Audit. We report on the development of a prototype tool to support the routine monitoring by clinical teams of early post-operative morbidities following paediatric cardiac surgery as part of a 4-year prospective multi-centre research study in the United Kingdom. The incidence of each complication was measured among 3090 cases between 1 October, 2015 and 30 June, 2017 at 5 United Kingdom centres In parallel to this data collection, we sought to develop a means for centres to, routinely and in a timely manner, monitor local morbidity rates using the incidence of each morbidity from the study data as a benchmark. We present the output of our study (Results section), including the final set of icons representing morbidities and the summary displays of morbidities data organised into an automatically generated Microsoft

Objectives

Methods

Results

Conclusion